Clinical structured reporting

ABSTRACT

Systems and methods for generating clinical structured reports, allowing users to indicate findings from a medical examination without having to enter normal findings. In one aspect, a user selects a clinical structured report template for a particular type of medical examination. A default clinical structured report based on the template, and comprising normal findings for the medical examination type, is presented to the user. The user modifies one or more of the normal findings to indicate abnormal findings. A clinical structured report is generated, based on the default normal findings and the abnormal findings received from the user. The report is stored in a database or sent to one or more recipients over a network. In one aspect, the normal findings comprise text data. In another aspect, the normal findings comprise plots, graphs, diagrams, or other types of data. In one aspect, the system provides for multi-language support and translations. In one aspect, the clinical structured report is used to generate billing information. In one aspect, the clinical structured report is generated by a computer aided diagnosis tool.

This application is a continuation of Ser. No. 12/276,174 filed Nov. 21,2008 which claims priority to U.S. Provisional Patent Application No.60/989,797 filed on Nov. 21, 2007.

FIELD

The present invention generally relates to document generation, and inparticular to creating a clinical structured report.

BACKGROUND

In many industries, such as the healthcare industry, technicians orspecialists evaluate data and generate written reports to be utilized byothers in providing a service or product. Other individuals refer to thewritten reports to provide the appropriate service or product to theconsumer. The process of creating the written reports, however, is atime-consuming and expensive process.

For example, radiologists diagnose diseases by analyzing radiologicalimages and generate written reports describing their findings. Onetechnology available to such specialists is the use of dictationsystems, such as a Dictaphone. The tapes are picked up bytranscriptionists and taken off-site for transcription. Approximately24-48 hours later, the transcribed reports are returned to theradiologist for corrections. The marked reports are picked up by thetranscriptionists and taken off-site for correction. The radiologistsand the transcriptionists continue in this manner until all correctionshave been incorporated into the transcribed report. Finally, theradiologist signs the corrected reports, and the corrected reports aremade available for distribution via runners, who typically hand-carrythe corrected reports to the requesting physicians.

Technologies such as fax and e-mail have eliminated the step ofphysically picking up the reports, thus, decreasing the amount of timerequired to produce the corrected reports. These technologies, however,fail to significantly impact the timeliness of the production of suchreports.

Tele-transcription systems reduce the dictation and transcription timebecause the systems allow radiologists to pick up an ordinary phone anddial into a dictation system provider and report their cases. Thesesystems eliminate the runners and cut transcription turnaround timesignificantly, to about 12-24 hours. Corrections to the reports,however, are still time-consuming.

Some systems utilize voice recognition technology in an attempt toreduce the dictation/transcription time. These voice recognitionsystems, however, have to be trained to each speaker's specific voicerecognition patterns, and the accuracy rates are too low for manyapplications, including radiology in which an accuracy rate of 95% isnot acceptable.

Corrections in many of these systems are even more cumbersome, and thesystems are expensive. Although the voice recognition system providesmany advantages, such as the electronic distribution of reports, thedisadvantages discussed above limit its usefulness.

Another technology available to such specialists is the use ofelectronic data entry systems, such as those utilizing hierarchicalinput nodes, similar to those mechanisms employed by programs such asMicrosoft Corporation's Windows Explorer program. Such systems require auser to select a parent node, the selection of which displays severalchild nodes. The user selects a child node, which may, in turn open upseveral other nodes. The parent node may describe general parts of theanatomy. The child node may describe sub-parts of the anatomy. The userthus searches through the node tree to find the appropriate node andselects that node. The selection of this node prompts the system to adda text to the report. Such techniques have several shortcomings in themedical context. For example, such hierarchical trees can be very largeand complex. A user is forced to search through the entire tree to findthe desired node, or to select through several hierarchies to find thedesired node. Further, the user goes through the process of selecting anode for each line of the report that the user wants to generate. Such asystem is both time-consuming and can be confusing, as a user notfamiliar with the layout of the nodal hierarchy will have to search theentire hierarchy for the desired selection.

Other systems employ a combination of node selection and voicerecognition to generate radiology reports. Users of such systems selecta single node to generate a normal report, and use voice recognitiontechnology to dictate a report with a finding of a medical abnormality.Such a system is prone to the same errors previously described withrespect to voice recognition technology.

The systems described generally begin with a blank report. The userpopulates the report by adding material to the blank report. Medicalreports are required to contain significant amounts of detail formedical billing practices (particularly promulgated by the insuranceindustry). This is true even if the report denotes normal or healthyfindings. Statistically, a significant proportion of medical reports,particularly radiology reports, are normal. Thus, systems that beginwith a blank report for the user to populate with normal as well asabnormal findings are both costly and time-consuming for an industrywhere the significant proportion of such reports are normal and containsimilar text and values.

The systems described are also plain text reports, and the consumer ofthat report must read carefully through the report in order to discernwhether the report discloses any medical abnormalities. Such a system isprone to errors in fast-paced environments, 15 where a medicalabnormality thus reported may be overlooked.

Furthermore, the systems described generally do not provide the reportsin an electronic form that enables a user to search across reports andcreate reports based on the content of a plurality of previouslycompleted reports. Rather, the systems generally only provide theability to search for specific strings of text contained within areport.

Therefore, the present invention advances the art by providing animproved technique that allows users to generate clinical reports.

SUMMARY

Systems and methods for generating clinical structured reports, allowingusers to indicate findings from a medical examination without having toenter normal findings. In one aspect, a user selects a clinicalstructured report template for a particular type of medical examination.A default clinical structured report based on the template, andcomprising normal findings for the medical examination type, ispresented to the user. The user modifies one or more of the normalfindings to indicate abnormal findings. A clinical structured report isgenerated, based on the default normal findings and the abnormalfindings received from the user. The report is stored in a database orsent to one or more recipients over a network. In one aspect, the normalfindings comprise text data. In another aspect, the normal findingscomprise plots, graphs, diagrams, or other types of data.

In one embodiment, the system provides for multi-language support andtranslations. In one embodiment, the clinical structured report is usedto generate billing information. In one embodiment, the clinicalstructured report is generated by a computer aided diagnosis tool.

BRIEF DESCRIPTION OF DRAWINGS

Referring now to the drawings in which like reference numbers representcorresponding parts throughout:

FIG. 1 illustrates a system for creating and managing clinicalstructured reports, in accordance with an embodiment of the presentinvention.

FIG. 1A is a flow diagram illustrating the process of generating aclinical structured report, in accordance with one embodiment of thepresent invention.

FIG. 2 illustrate example portions of an initial clinical structuredreport, in accordance with an embodiment of the present invention.

FIGS. 3 and 4 illustrate example user interfaces for creating a clinicalstructured report, in accordance with an embodiment of the presentinvention.

FIGS. 5A-5F illustrate different views of one particular example of astructured clinical report.

FIG. 6 illustrates a clinical structured report created in accordancewith an embodiment of the present invention. Specifically, the figureillustrates further user interface elements for selecting or specifyingan abnormality.

FIG. 7 illustrates a completed clinical structured report in accordancewith an embodiment of the present invention.

FIGS. 8-10 illustrate user interface elements for modifying a templatefor an example clinical structured report in accordance with anembodiment of the present invention. FIG. 8 illustrates the choice ofvarious templates for a set of example clinical structured reportsaccording to embodiments of the present invention. FIG. 9 illustratesthe consequence of selecting a template of a clinical structured reportof FIG. 8, in accordance with an embodiment of the present invention.FIG. 10 illustrates the consequence of selecting a template of aclinical structured report of FIG. 9, as well as the ability to edit thestandard normal templates of the clinical structured report inaccordance with embodiments of the present invention.

DETAILED DESCRIPTION

In the following description, for purposes of explanation, numerousspecific details are set forth in order to provide a thoroughunderstanding of the invention. It will be apparent, however, to oneskilled in the art that the invention can be practiced without thesespecific details.

It is further noted that, unless otherwise indicated, all functionsdescribed herein may be performed by either hardware or software, orsome combination thereof. In a preferred embodiment, however, thefunctions are performed by a processor such as a computer or anelectronic data processor in accordance with code such as computerprogram code, software, and/or integrated circuits that are coded toperform such functions, unless otherwise indicated.

Reference in this specification to “one embodiment” or “an embodiment”means that a particular feature, structure, or characteristic describedin connection with the embodiment is included in at least one embodimentof the invention. The appearances of the phrase “in one embodiment” invarious places in the specification are not necessarily all referring tothe same embodiment, nor are separate or alternative embodimentsmutually exclusive of other embodiments. Moreover, various features aredescribed which may be exhibited by some embodiments and not by others.Similarly, various requirements are described which may be requirementsfor some embodiments but not other embodiments.

As employed herein, the term “patient” shall mean a living member of theanimal kingdom including human beings

The present invention provides a method for generating a clinicalstructured report. As one of ordinary skill in the art will appreciate,the present invention applies to any area in which a report is to begenerated for use by other individuals or groups. For example, anembodiment of the present invention may be utilized in radiological,toxicological, pharmaceutical, other healthcare specialties, or thelike. For illustrative purposes only, however, the following descriptiongenerally provides examples specific to one or more types of reports,such as radiology and reports generated by radiologists, radiologytechnicians, or other radiology support staff.

As will be discussed in greater detail below, an embodiment of theinvention allows a user to generate clinical structured reports from adefault template pre-filled to show normal radiology findings. Forexample, the radiologist or user can use and access an embodiment of theinvention on a computer to generate a radiology report. An embodiment ofthe invention displays a default template showing descriptions or valuesindicative of normal radiology findings to the user. The normal valuesdescribe names and normal characteristics of both the general andspecific anatomy that is the subject of the radiology report.

A user interface displays the default report and includes one or moreuser interface elements for confirming the values shown in the defaultreport. Such a confirmation generates a report showing that general andspecific anatomy exhibit normal characteristics. The user interface alsodisplays one or more user interface elements for allowing users toindicate that some of the findings in the radiology exam at handindicate one or more abnormalities (hereinafter also referred to asabnormal findings). Such a selection will preferably prompt the user toinput the specifics of the abnormality, for example via one or more dropdown menus or optionally through manual entry of the details of theabnormality. In one embodiment, the normal findings comprise text data.In other embodiments, the normal findings may also comprise plots,graphs, diagrams, or other types of data.

Referring to FIG. 1 of the drawings, the reference numeral 100 generallydesignates a reporting system, which embodies features of the presentinvention. Generally, the reporting system 100 comprises one or moreinterface devices 102, such as computers, cell phones, appliances,personal digital assistants (PDAs), television systems, etc. Theinterface device 102 preferably includes a processor, one or more datacommunications devices (e.g., modems, network interfaces, etc.), amonitor (e.g., CRT, LCD display, etc.), and one or more input devices(e.g., a mouse and/or a keyboard). It is envisioned that attached to theclient computer may be other devices such as random-access memory (RAM),read-only memory (ROM), a video card, bus interfaces, printers, and thelike. The interface device 102 is configured to allow a user 103 toenter data regarding observations that user 103 has made regarding asubject, patient, or image (not shown). For the purposes of describingthe invention, user 103 will have the same meaning as “user” or “users”.

Optionally, the interface device 102 is coupled to a server 101. Theserver 101 is preferably coupled to a database 104, which receives,stores, and sends data generated by one or more users. Database 104 alsoreceives, stores, and sends default or modified templates that are usedto generate clinical structured reports, in accordance with anembodiment of the present invention. Changes to the templates stored indatabase 104 are reflected in the generated reports. The server 101 ispreferably a server accessible via an internal network to enable sharingof templates, generated data, and reports. Optionally, server 101 isalso accessible via an external network, such as the Internet, to whichthe interface device 102 couples via a communications link, such as aTCP/IP communications link, a wireless communications link, or the like.The present embodiments allow for single user as well as multi userconfigurations. One or more users may be interacting with the systemconcurrently or sequentially when performing tasks such as viewing areport, filling a report, modifying a report or template or interactingwith a system in any other way as described herein.

FIG. 1A is a flow diagram illustrating the process of generating aclinical structured report, in accordance with one embodiment of thepresent invention. At step 151, a user selects a report for a medicalexamination. At step 152, a user interface is presented to the user, theuser interface indicating the selected report and initialized from atemplate comprising pre-filled values denoting normal findings for theselected medical exam. An example portion of such an initial report userinterface is shown in FIG. 2, illustrating a portion of an examplereport for a medical exam of the liver and spleen as the report evolvesaccording to the various steps of FIG. 1A. While the example reportshown in FIG. 2 is generated from an exemplary template with pre-filledvalues denoting a normal medical exam of the liver and spleen, it isunderstood that this represents an exemplary embodiment and that reportsfor other medical exams can be generated in a similar manner.

At step 153, the user may modify the presented report user interface,which indicates pre-filled normal findings, in order to indicate actualfindings from an actual medical exam. The user may do this, for example,by electing to edit the comments, as shown in the user interface 201 aof FIG. 2. User interface 201 b shows what is displayed to the user uponclicking an exemplary “Edit Comment” button of user interface 201 a.Upon completion of the edit, the user may save the edited comment, forexample by clicking a “Save Comment” button on the user interface ofuser interface 201 b, upon which server 101 stores the edited commentsinto database 104, reflecting the actual medical findings as indicatedand saved by the user. Upon storage of the actual findings, a userinterface 201 c is displayed to the user, presenting the user'smodifications. For illustrative purposes, this is shown in userinterface 201 c of FIG. 2 using the phrase “MORE COMMENTS ADDED.”

Alternatively, the user may choose to cancel the most recent edits, forexample by clicking on a “Cancel” button as shown in interface 201 b,upon which time the original user interface 201 a is displayed to theuser again. Alternatively, the user may choose to reset the presenteduser interface according to the pre-filled normal findings of theparticular medical report template, for example by clicking on the“Reset” button as shown as shown in interface 201 b, upon which time theServer 101 retrieves the normal findings from database 104 (or from acache) and presents them once again as in user interface 201 a.

Still referring to FIG. 2, the user may also interact with userinterface 201 a in a more structured fashion in order to denote anabnormality, for example by clicking the “Check for Abnormal” checkbox.The server 101 may then present to the user a more structured interface,for example such as interface 201 d of FIG. 2, prompting the user toinput further information regarding the abnormality. The server 101 anddatabase 104 may be configured to present any suitable interface forentering abnormal findings, as appropriate for the particular medicalreport and as depending on any other relevant factors. The user mayinteract with user interface 201 d to indicate one or more abnormalfindings, and may then save the findings, for example by clicking on a“Save Comment” button as shown in 201 d. Thereupon, the server 101 savesthe findings, and subsequently presents a user interface indicating theuser's findings in text form, such as shown in interface 201 e. The usermay continue to interact with user interface 201 e to refine the nextform of the findings, for example to add more comments. When done, theuser may click on “Save Comments” to save the edits, whereupon theserver 101 may present user interface 201 f to the user indicating theuser's edited findings. At this point, the user may indicate completion,or the user may alternatively further interact with interface 201 f to“Edit Comments” (going back to 201 e) or choose “Reset” (going back to201 d).

FIGS. 3 and 4 illustrate the process of accessing a template for aclinical structured report in accordance with an embodiment of thepresent invention. FIG. 3 illustrates a general patient file that user103 may access via a database or through a network. User 103 selects“Create a New Exam” in order to initiate the creation of a new clinicalstructured report for the selected patient. FIG. 4 illustrates aconsequence of selecting “Create a New Exam” in FIG. 3. FIG. 4illustrates the retrieval or entry of the details of the patient'sexamination, the details being optionally retrieved from commonlyutilized hospital network systems such as Hospital Information Systems(HIS), Radiology Information Systems (RIS), Picture ArchivingCommunications Systems (PACS), or other suitable system.

The clinical structured report comprises of one or more sections toindicate normal clinical or medical findings, and preferably one or moresections containing patient identifying information. FIGS. 5A-5Cillustrate different views of one particular example of a structuredclinical report (as indicated by the scroll bar on the right). Theexample report shown is a radiology report, and has sections 501 a, 501b, 501 c, 501 d, 501 e, 501 f, 501 g, and so on (best seen in FIG. 5B).As described above, these sections are pre-filled from a normalradiology template in order to indicate normal radiology findings.Preferably, these findings describe both the general and specificanatomy of the radiology subject, though the individual sections neednot necessarily correspond directly to only one named part of thesubject's anatomy. For example, report 501 is a CT Scan of theBrain/Head, the sections 501 a through 501 f (best seen in FIG. 5B) arefound within the general anatomical description “Intracranial,”referring to the general intracranial portions of the Brain/Head.However, in the particular example best seen in FIG. 5B, sections 501 athrough 501 f (best seen in FIG. 5B) comprise descriptions of thosespecific portions of anatomy, and descriptions of the normalcharacteristics of those anatomies. For example, section 501 a indicates“Cerebral Hemispheres” and includes a description of medically orclinically normal cerebral hemispheres.

Referring to FIG. 5C, to produce a radiology report indicating noabnormalities, user 103 interacts with an element of the user interface,for example by clicking on “Click Here to Validate”. Thus, a detailedreport is produced by minimal interaction with the user, in thisparticular example via one click. This system is desirable forhospitals, where a significant proportion of reports are normal, as itdrastically reduces the production time for documents and reduces errorsassociated with voice recognition technology. Furthermore, it promoteslinguistic and visual uniformity of medical reports.

To produce a report indicating the presence of abnormalities, user 103may disaffirm the report by interacting with an element of the userinterface, for example by clicking a box under the heading “Check forAbnormal” (the heading is best seen in FIG. 5A). A selection of“Abnormal” prompts the user 103 to enter further information about theabnormality into the report. FIG. 6 shows an example user interface foraccepting such information from user 103. In one embodiment, the promptincludes a series of one or more check boxes and/or drop-down menus withpre-filled portions of text. Once the user 103 indicates his selections,the selections are assembled into a data structure indicating aparagraph or other structure for storage in database 104.

Alternatively, the user interface may include a text box (as seen inFIGS. 5C, 5D, and 5E, section 502), which the user 103 can modify withany desired text.

Alternatively, for either a normal or abnormal report, user can modifythe pre-existing template through entry into a text box (as shown inFIG. 5F, section 501 a).

Referring to FIG. 7, optionally the clinical structured report thusproduced comprises visual cues such as highlights or flags of any fieldsmarked as abnormal. In one embodiment, such visual cues appear at thevarious stages of producing the report. For example, the parts of thereport shown in FIG. 7 denoting an abnormality may be highlighted withvisual cues. As another example, the parts of the working report shownin FIGS. 5D and 6 denoting the abnormality may be highlighted as well.Further, the report may be generated on a screen or other suitableelectronic display, in a paper printout, in an electronic document, on astorage medium, or in any other suitable format. Inclusion of visualcues is advantageous, especially in a fast-paced environment whereabnormalities may be overlooked or need to be called out visually foradditional convenience or safety.

A user may customize an existing template or create a new template.FIGS. 8, 9, and 10 illustrate the process of such customization. FIG. 8illustrates the starting point for the customization of an existingtemplate for an example abdominal exam. User 103 selects one of thetemplate reports to modify, for example by clicking on it. Optionally,once user 103 selects the template, the user is presented to a userinterface for selecting from one or more specific sub-templates, forexample such as shown in FIG. 9. In the example shown, user 103 selectsfrom one or more specific sub-templates in the menu on the left handside of the screen.

Optionally, once user 103 selects a sub-template, the user is presentedwith an interface, such as the screen shown in FIG. 10, showing amodifiable template. The modifiable template comprises one or moresections, shown here as sections 1001 a and 1001 b, which will allow theuser to pre-fill values for both normal and abnormal radiologicalreports, thereby defining the template.

While the above embodiments have been described generally with respectto normal and abnormal findings that are represented in text form, it isan advantageous aspect that the clinical structured reports mayoptionally comprise non text data, such as data plots, diagrams, images,etc., as will be presently described.

For example, in a medical ultrasound examination of an obstetricalpatient, an ultrasound operator may measure one or more fetalbiometrics. For example, the ultrasound operator may measure the size ofcertain elements of the fetal anatomy, such as the head, abdomen,extremities, etc. This ultrasound image data is then transferred fromthe ultrasound equipment into a database, such as database 104 or otherdatabase, as part of the patient's record (i.e. the mother, in thiscase). Such ultrasound image data often represents a significant portionof the patient's periodic ultrasound examination results. The system 100may be configured to apply one or more mathematical computations (suchas regressions, standard deviations, etc.) for fetal growth, as areknown in the art, to the data stored in the database 104. For example,such computations may be applied to the fetal age, fetal weight, or toother data gathered from the examination. Results of such computationsmay then serve as statistical data points which can be correlated withthe various dates of the periodic ultrasound examinations which aregenerally performed throughout the pregnancy. For example, such datapoints may be tracked graphically as serial data points plotted on atrend line to display progress of normal or abnormal fetal growth. Aclinical structured report, as described herein, may comprise pre-filledgraphical representations based on normal data points that areindicative of normal fetal growth, and which are part of an obstetricalultrasound examination template stored on database 104. The actual dataproduced by the examination may then be used to juxtapose the actualfindings against normal findings, in order to determine abnormalities ordeviations from norm (if any). Optionally, and as also described above,abnormal data may be color coded or otherwise visually highlighted fordisplay.

As another example, a clinical structured report for a blood flowexamination may comprise one or more anatomical images, diagrams, linedrawings, etc., of blood vessels, and may indicate blood flow, forexample blood velocity and direction. For instance, for a patientsuffering from stenosis of arteries (e.g. in the neck or other part ofthe body), a Doppler ultrasound examination as part of a carotidvascular examination may measure the flow of blood in the carotidartery, with the ultrasound measurements helping to determine a degreeof narrowing of the affected blood vessel lumen. Therefore, a templatefor such a clinical structured report may comprise an image, diagram,line drawing, or other representation of the artery, indicating normalfindings for such an examination (such as normal ranges for blood flow,normal blood flow ratios, etc.). During or after the medicalexamination, the system 100 would allow a user to simply confirm normalfindings, or to indicate abnormal findings by drawing onto (e.g. with acomputer drawing tool), or by otherwise interacting with, the diagram inorder to indicate the obtained data, such as the measured blood flowthrough the stenosis. As with the above embodiment, this allows the userto indicate abnormal findings of the examination without having to alsoenter all the normal findings. Optionally, the system 100 may also beconfigured apply mathematical equations in order to arrive at blood flowratios (as known in the art) in order to determine the significance ofthe stenosis. As with the above embodiments, template images, graphs,plots, diagrams, etc. may be used in a wide variety of structuredmedical report templates for a variety of medical examinations.

As another example, a clinical structured report may comprise one ormore anatomical images, diagrams, line drawings, etc., of a region ofanatomy, such as the brain or other organ, indicating normal ranges forthe size or other characteristics of the region or organ. This allows auser of system 100 to indicate any abnormal findings of a medicalexamination into a clinical structured report. For example, the user mayindicate an abnormal size or other characteristic of the region, or drawand indicate a size or other characteristics of an abnormal mass foundin the region, for example by using a drawing tool to draw onto theprovided diagram, or by choosing from one or more abnormal selections,etc.

Optionally, the present embodiments also comprise multi-languagecapabilities. For example, the user interface may allow the user todynamically select among a plurality of supported languages (such asEnglish, Spanish, German, French, etc.) and dynamically modify the userinterface to present the normal findings, as well as the abnormalfindings, in the user selected language. In such an embodiment, thedefault template would store the normal findings, as well as thecollection of available abnormal findings, in the supported languages sothey can be presented accordingly upon the user's language selection.Optionally, the system may be configured to receive normal and abnormalfindings from the user in one language, and present and/or report themin another language. For example, the user interface may allow thefindings to be entered in Spanish (or in any other supported language),and the system may then display and/or store the report in English (orin any other language). In such embodiments, the normal and abnormalfindings stored in report templates may be pre-translated (i.e.,“canned’), and the system may optionally provide for on-the-flytranslations and/or post-process translations.

Optionally, the clinical structured report may comprise links or otherresource identifiers to supplementary data. The server 101 may use suchlinks or resource identifiers to assemble the supplementary data intothe report for presentation to the user. For example, the report maycontain a reproduction of one or more radiology exam images or a link tosuch images (not shown), audio files from the exam, video files from theexam, or other supplementary data. Such supplementary data may reside indatabase 104, a separate storage system, a network resource, orelsewhere.

Optionally, the server 101 distributes the clinical structured reportvia a public or private network such as the Internet. For example, theserver may e-mail the report from one user to another, or distribute itin any other common fashion as should be obvious to one of ordinaryskill in the art.

In another embodiment of the invention, the clinical structured reportis electronically transmitted to a portable wireless device. Forexample, the report, along with any images or other data it may contain,may be transmitted to a mobile device (such as a mobile phone, laptopcomputer, handheld device, etc.), where it may or may not be modified bya user.

Optionally, the generation of the clinical structured report triggersgeneration of billing information. For example, after the generation ofa report, the server may generate a bill or invoice for the examiningphysician's services, and send the bill or invoice to the appropriaterecipient or submit it electronically according to a billing protocol.

Optionally, the clinical structured report is automatically generated bya computer-aided diagnostic tool. For example, a software program, or acombination of software and hardware elements, may study data or imagesobtained from clinical exams or tests residing on the database, on anetwork resource, or elsewhere. Once the software program identifies anymedical abnormalities, or lack thereof, the reports of the presentembodiments may be used to communicate any diagnoses, along withfindings from such exams. A report thus created may be affirmed ordisaffirmed by a reviewing physician.

While the above is a complete description of the preferred embodimentsof the invention, various alternatives, modifications, and equivalentsmay be used. Therefore, the above description should not be taken aslimiting the scope of the invention which is defined by the appendedclaims.

What is claimed is:
 1. A method of automatically generating clinicalstructured reports based on clinical structured report templates, themethod implemented by one or more report management computing devices,the method comprising: providing a clinical structured report templatefor a medical examination based on a received user selection input ofthe medical examination, the clinical structured report templateassociated with medical data comprising medical examination data pointsfor the selected medical examination, wherein the clinical structuredreport template is automatically pre-populated with default normal datapoints corresponding to the medical examination data points; receivingone or more abnormal data points related to one or more of the medicalexamination data points based on the medical examination of a patient;automatically generating a clinical structured report based on theclinical structured report template, wherein the generated clinicalstructured report includes modifications to one or more of theautomatically pre-populated default normal data points in the clinicalstructured report template based on the abnormal data points; andgenerating and outputting executable instructions for a graphical userinterface display of the clinical structured report.
 2. The method ofclaim 1 further comprising: providing a default collection of abnormaldata points; and receiving the one or more abnormal data points based onanother received user selection input from the default collection ofabnormal data points.
 3. The method of claim 1 further comprising:providing visually highlighting of the modifications to one or more ofthe automatically pre-populated default normal data points in theclinical structured report template based on the abnormal data points onthe graphical user interface.
 4. The method of claim 1, wherein theclinical structured report further comprises additional data related tothe medical examination, wherein the additional data comprises one ormore of image data, audio data, or video data related to the medicalexamination, or data points corresponding to prior medical examinationdata from a prior medical examination of the patient displayed on thegraphical user interface.
 5. The method of claim 1 further comprising:distributing the clinical structured report to one or more remoterecipients over a network.
 6. The method of claim 1 further comprising:generating an automated billing statement based on the clinicalstructured report.
 7. The method of claim 1, wherein the one or moreabnormal data points related to one or more of the medical examinationdata points based on the medical examination are received based on auser interaction with the graphical user interface.
 8. A reportmanagement computing device, comprising memory comprising programmedinstructions stored thereon and one or more processors configured toexecute the stored programmed instructions to: provide a clinicalstructured report template for a medical examination based on a receiveduser selection input of the medical examination, the clinical structuredreport template associated with medical data comprising medicalexamination data points for the selected medical examination, whereinthe clinical structured report template is automatically pre-populatedwith default normal data points corresponding to the medical examinationdata points; receive one or more abnormal data points related to one ormore of the medical examination data points based on the medicalexamination of a patient; automatically generate a clinical structuredreport based on the clinical structured report template, wherein thegenerated clinical structured report includes modifications to one ormore of the automatically pre-populated default normal data points inthe clinical structured report template based on the abnormal datapoints; and, generate and output executable instructions for a graphicaluser interface display of the clinical structured report.
 9. The deviceof claim 8, wherein the processors are further configured to be capableof executing the stored programmed instructions to: provide a defaultcollection of abnormal data points; and receive the one or more abnormaldata points based on another received user selection input from thedefault collection of abnormal data points.
 10. The device of claim 8,wherein the processors are further configured to be capable of executingthe stored programmed instructions to: provide visually highlighting themodifications to one or more of the automatically pre-populated defaultnormal data points in the clinical structured report template based onthe abnormal data points on the graphical user interface.
 11. The deviceof claim 8, wherein the clinical structured report further comprisesadditional data related to the medical examination, wherein theadditional data comprises one or more of image data, audio data, orvideo data related to the medical examination, or data pointscorresponding to prior medical examination data from a prior medicalexamination of the patient displayed on the graphical user interface.12. The device of claim 8, wherein the processors are further configuredto be capable of executing the stored programmed instructions to:distribute the clinical structured report to one or more remoterecipients over a network.
 13. The device of claim 8, wherein theprocessors are further configured to be capable of executing the storedprogrammed instructions to: generate an automated billing statementbased on the clinical structured report.
 14. The device of claim 8,wherein the one or more abnormal data points related to one or more ofthe medical examination data points based on the medical examination arereceived based on a user interaction with the graphical user interface.15. A non-transitory computer readable medium having stored thereoninstructions for automatically generating clinical structured reportsbased on clinical structured report templates comprising executable codethat, when executed by one or more processors, causes the processors to:provide a clinical structured report template for a medical examinationbased on a received user selection input of the medical examination, theclinical structured report template associated with medical datacomprising medical examination data points for the selected medicalexamination, wherein the clinical structured report template isautomatically pre-populated with default normal data pointscorresponding to the medical examination data points; receive one ormore abnormal data points related to one or more of the medicalexamination data points based on the medical examination of a patient;automatically generate a clinical structured report based on theclinical structured report template, wherein the generated clinicalstructured report includes modifications to one or more of theautomatically pre-populated default normal data points in the clinicalstructured report template based on the abnormal data points; andgenerate and output executable instructions for a graphical userinterface display of the clinical structured report.
 16. Thenon-transitory computer readable medium of claim 15, wherein theexecutable code, when executed by the processors further causes theprocessors to: provide a default collection of abnormal data points; andreceive the one or more abnormal data points based on another receiveduser selection input from the default collection of abnormal datapoints.
 17. The non-transitory computer readable medium of claim 15,wherein the executable code, when executed by the processors furthercauses the processors to: provide visually highlighting of themodifications to one or more of the automatically pre-populated defaultnormal data points in the clinical structured report template based onthe abnormal data points on the graphical user interface.
 18. Thenon-transitory computer readable medium of claim 15, wherein theclinical structured report further comprises additional data related tothe medical examination, wherein the additional data comprises one ormore of image data, audio data, or video data related to the medicalexamination, or data points corresponding to prior medical examinationdata from a prior medical examination of the patient displayed on thegraphical user interface.
 19. The non-transitory computer readablemedium of claim 15, wherein the executable code, when executed by theprocessors further causes the processors to: distribute the clinicalstructured report to one or more remote recipients over a network. 20.The non-transitory computer readable medium of claim 15, wherein theexecutable code, when executed by the processors further causes theprocessors to: generate an automated billing statement based on theclinical structured report.
 21. The non-transitory computer readablemedium of claim 15, wherein the one or more abnormal data points relatedto one or more of the medical examination data points based on themedical examination are received based on a user interaction with thegraphical user interface.